Approximately one in five U.S. health facilities don't make alcohol-based hand sanitizer available at every point of care, missing a critical opportunity to prevent health care-associated infections, according to new research from Columbia University School of Nursing and the World Health Organization (WHO) published in the American Journal of Infection Control. The study, which examined compliance with WHO hand hygiene guidelines in the U.S., also found that only about half of the hospitals, ambulatory care, and long-term care facilities had set aside funds in their budgets for hand hygiene training.

A research team jointly led by Laurie Conway, RN, MS, CIC, PhD student at Columbia Nursing, and Benedetta Allegranzi, MD, lead of the WHO infection control program Clean Care is Safer Care, surveyed compliance with WHO hand hygiene guidelines at a sample of 168 facilities in 42 states and Puerto Rico. Overall, 77.5% of facilities reported that alcohol-based sanitizer was continuously available at every point of care, the study found. About one in ten facilities reported that senior leaders such as the chief executive officer, medical director, and director of nursing didn't make a clear commitment to support hand hygiene improvement, according to the study.

"When hospitals don't focus heavily on hand hygiene, that puts patients at unnecessary risk for preventable health care-associated infections," says Conway. "The tone for compliance with infection control guidelines is set at the highest levels of management, and our study also found that executives aren't always doing all that they can to send a clear message that preventing infections is a priority."

Hand hygiene is critical to preventing health care-associated infections, which kill about 100,000 people a year in the U.S. and cost about $33 billion to treat. The Centers for Disease Control and Prevention issued guidelines for hand hygiene in 2002, and the WHO followed suit in 2009.

"The survey also shows that facilities participating in the WHO global hand hygiene campaign achieved a higher level of progress," says co-author Prof. Didier Pittet, MD, MS, Director, Infection Control Program and WHO Collaborating Center on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. "While hand hygiene compliance is the responsibility of every health care worker, U.S. health care facilities would certainly benefit from coordinated national and sub-national efforts aimed at hand hygiene improvement. They would also gather innovative ideas and trans-cultural approaches by participating in global efforts such as the WHO campaign."

The paper is titled: "Status of the implementation of the World Health Organization multimodal hand hygiene strategy in United States of American health care facilities." Elaine Larson, PhD, RN, FAAN, associate dean for research at Columbia Nursing, also contributed to the study.

The authors declare no financial or other conflicts of interest.

Columbia University School of Nursing is part of the Columbia University Medical Center, which also includes the College of Physicians & Surgeons, the Mailman School of Public Health, and the College of Dental Medicine. With close to 100 full-time faculty and 600 students, the School of Nursing is dedicated to educating the next generation of nurse leaders in education, research, and clinical care. The School has pioneered advanced practice nursing curricula and continues to define the role of nursing and nursing research through its PhD program which prepares nurse scientists, and its Doctor of Nursing Practice (DNP), the first clinical practice doctorate in the nation. Among the clinical practice areas shaped by the School's research are the reduction of infectious disease and the use of health care informatics to improve health and health care. For more information, please visit: http://www.nursing.columbia.edu.

AJIC: American Journal of Infection Control covers key topics and issues in infection control and epidemiology. AJIC is the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

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